Intra-tracheal malposition of endotracheal tubes in newborns: a retrospective single-center study.

OBJECTIVE

to describe intra-tracheal tube malposition in newborns and evaluate potential predictors.

DESIGN

retrospective single-center study.

SETTING

French quaternary referral hospital comprising 12 neonatal intensive care unit and 12 pediatric intensive care unit beds.

PATIENTS: term newborns less than 28 days old and preterm newborns under 28 days corrected age, firstly intubated 01/01/2023 - 12/31/2023 irrespective of the intubation site.

MAIN OUTCOME MEASURES: endotracheal tube (ET) distal tip on first chest X-ray after intubation, blindly reviewed by two independent observers, and extensive data regarding intubation and first post-intubation chest X-ray.

RESULTS

one-hundred seventy-eight newborns were included, nearly half premature and half terms (median gestational age at intubation: 36 wk, IQR 28 - 40). Twenty-eight (15.7%) died within hospital discharge. Overall proportion of ET malposition was 63.5% (95% CI 56.4 - 70.6), including 17.4% mainstem intubations. Only weight at intubation was an independent determinant for ET malposition in a multivariate analysis (aOR 10.3; 95% CI 2.06 - 63.7 when intubation's weight was below 1000 g), with a strong trend between weight categories and ET malposition rates. However, ET malposition was not an independent risk factor for death (aOR 1.93; 95% CI 0.65 - 6.54).

CONCLUSIONS

intra-tracheal malposition of endotracheal tubes is extremely frequent in the neonatal population and can be prominently explained by a low weight at intubation implying a short trachea. Clear new strategies are mandatory to determine prior to intubation the ideal endotracheal tube depth marking and to accurately assess the intra-tracheal position of the tube after intubation.